Pterygium is a common eye condition, characterized by the growth of a fleshy, fibrovascular tissue on the conjunctiva extending to reach the cornea. In some cases, pterygium can cause discomfort, redness, irritation, and even affect vision if it grows over the cornea.[1]
Traditional surgical techniques, such as excision with bare sclera or conjunctival autograft, have been the standard treatment for pterygium excision for many years. The drawback is the recurrence rate which remains always high, especially if the patient is young.[2]
However, in recent years, advancements in medical technology have introduced laser-assisted pterygium surgery as an alternative approach to reduce the recurrence rate. This technique has gained popularity due to its potential advantages over traditional methods.
All types of laser such as excimer, Yag, and Argon have been applied for pterygium surgery to reduce the recurrence rate.[1,2,3,4,5]
In a study published in the current issue of Oman J Ophthalmol titled “Evaluating the application of argon laser on Pterygium surgery: report of 30 patients,” the authors used argon laser preoperatively, targeting the big and prominent vessels.[6] The feeding arteries of the pterygium were hit with a distance of 2 mm from the limbus in the form of two parallel columns, 1–2 mm apart. In order to achieve ablation of vessels (made visible using a slit lamp), a power setting of 300–500 with a duration of 0.1 s and a spot size of 50 μ were used by the VALON multispot laser (Valon STA, Finland). The process was repeated 2–3 times, and patients were given dicloptin (0.1%, ophthalmic drop) and clobiotic for 6 weeks (every 6 h; 3 weeks before and 3 weeks after surgery).
One of the main benefits of using lasers in pterygium surgery is the precision and control they offer. The laser can accurately target prominent pterygium vessels. This precision is particularly crucial to avoid damage to the surrounding structures. However, we may need more studies in future to explore the possibility of potential complications from this procedure such as stem cell damage, scleral thinning, and perforation.[3]
Laser-assisted surgery can significantly reduce bleeding during the procedure. In addition, it can give a better view of the underlying structures during surgery. Femtosecond lasers have been applied for autograft preparation.[7] Argon has been used to cauterize conjunctival vessels before and after pterygium excision. The use of these laser modalities in pterygium surgery needs certain training and experience.
Patients who undergo pterygium surgery with a laser may experience a faster recovery than traditional methods. The laser's precise and less invasive nature can lead to less tissue trauma, reduced inflammation, and ultimately quicker healing. As a result, patients may experience less postoperative discomfort and a faster return to normal daily activities.
One of the significant challenges in pterygium surgery is the risk of recurrence. Laser-assisted surgery has shown promising results in reducing the likelihood of recurrence due to potential suppression of regrowth.
Mitomycin C use in pterygium surgery has also been tried to reduce the risk of recurrence further, considering its possible serious complications.[2,3] Comparative studies between laser-assisted and Mitomycin C-assisted surgeries could be necessary to find out the effectiveness of these modalities. The combination of those two techniques could be more effective in reducing the rate of recurrence in high risk patients.
While laser-assisted pterygium surgery offers several advantages, it also has its limitations. The accessibility of this technique may be limited in some regions due to the cost of laser equipment and the need for specialized training. In addition, not all pterygium cases may be suitable for laser surgery and the decision to use this approach should be made on a case-by-case basis by the surgeon, considering factors such as the size and location of the pterygium.
Laser-assisted pterygium surgery is a promising and innovative approach to treat this common eye condition. Its precision, reduced bleeding, and potentially lower recurrence rates make it an attractive option for patients and ophthalmic surgeons.
References
- 1.Ajayi Iyiade A, Omotoye Olusola J. Pattern of eye diseases among welders in a Nigeria community. Afr Health Sci. 2012;12:210–6. doi: 10.4314/ahs.v12i2.21. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Kaufman SC, Jacobs DS, Lee WB, Deng SX, Rosenblatt MI, Shtein RM. Options and adjuvants in surgery for pterygium: A report by the American Academy of Ophthalmology. Ophthalmology. 2013;120:201–8. doi: 10.1016/j.ophtha.2012.06.066. [DOI] [PubMed] [Google Scholar]
- 3.Awwad AA, Abd-Elsabour SS, EL-Dein NS. Effect of argon laser before and after surgery on primary pterygium recurrence. Sci J Al Azhar Med Fac Girls. 2021;5:535–9. [Google Scholar]
- 4.Bamdad S, Kooshki AS, Yasemi M. Surgical outcome of conjunctival rotational autograft-mitomycin C (MMC) versus free conjunctival autograft-MMC for pterygium removal: A randomized clinical trial. Electron Physician. 2017;9:5877–84. doi: 10.19082/5877. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Apaydin KC, Duranoglu Y, Saka O, Demirbas N. Argon laser treatment of pterygium Ann Ophthalmol. 2002;34:26–9. [Google Scholar]
- 6.Arish M, Dakkali MS. Evaluating the application of argon laser on pterygium surgery: Report of 30 patients. Oman J Ophthalmol. 2023;16:478–81. doi: 10.4103/ojo.ojo_59_23. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Liu YC, Ji AJ, Tan TE, Fuest M, Mehta JS. Femtosecond laser-assisted preparation of conjunctival autograft for pterygium surgery. Sci Rep. 2020;10:2674. doi: 10.1038/s41598-020-59586-z. [DOI] [PMC free article] [PubMed] [Google Scholar]